Hepatitis C health promotion and the anomalous sexual subject

Abstract

Research shows that diagnosis with the blood-borne liver disease hepatitis C can lead to significant changes in intimate relationships, including a reduction in sexual contact and avoidance of new relationships. This article examines hepatitis C health promotion materials and their treatment of sexuality and sexual transmission. The article analyses 21 Australian hepatitis C health promotion resources collected as part of research degree project exploring the interrelationships between hepatitis C, injecting drug use, HIV and the body. It uses the work of theorist Margrit Shildrick on the ‘anomalous’ body, and a discourse analysis method, to understand these interrelationships and their metaphorical and symbolic implications. Our analysis shows that health promotion materials regularly present information about sexual transmission in ways likely to add to confusion and uncertainty about risk. Despite regular acknowledgements that hepatitis C is not a sexually transmissible infection, some resources place an inappropriately heavy focus on the possibility of hepatitis C transmission via heterosexual activity. Others contain mixed messages about the possibility for disease transmission through sex, at the same time enjoining hepatitis C positive readers to practise safe sex. We argue that these injunctions are linked to the ways that the resources figure people living with hepatitis C as intrinsically anomalous. In doing so, the resources run the risk of inadvertently naturalising stigma, anxiety and fear surrounding intimate contact. The article concludes by noting that agencies responsible for the delivery of health promotion need to carefully examine the messages they produce if they are to avoid creating uncertainty and anxiety about the implications of hepatitis C for sexuality and intimacy.

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Notes

  1. 1.

    The natural history of hepatitis C disease varies significantly for each individual, but in general it is a slowly progressing condition. It is estimated that 70–80 per cent of people who are exposed to hepatitis C do not clear the virus and develop chronic infection. Of these, between 30–40 per cent remain asymptomatic and 60–70 per cent experience consistent or sporadic abnormal liver function. After 20 years, 5–10 per cent of those infected progress to cirrhosis and after 40 years 3–5 per cent develop liver cancer or liver failure (Dore, 2001).

  2. 2.

    REVISED FROM: Some people, unable to identify any other risk factors, believe they may have contracted hepatitis C sexually. In addition, some research suggests that a small percentage of people do contract hepatitis C through sexual contact. Thus, transmission of hepatitis C during sex is seen as possible but believed to be rare [emphasis added] (Hepatitis NSW, 2008; Hepatitis NSW, 2009, p. 64). Hepatitis NSW (2008) Hep C factsheets: Sex and Hepatitis C transmission. Hepatitis NSW, NSW. TO: Some research suggests that a small percentage of people do contract hepatitis C through blood to blood contact that may occur during sexual contact. Thus, transmission of hepatitis C during sex is seen as possible but believed to be rare (Hepatitis NSW, 2011 factsheet). REMOVED FROM: Hepatitis NSW (2009) What you need to know: A guide to hepatitis C. Hepatitis NSW, NSW.

  3. 3.

    Bondage and discipline/domination and submission.

References

  1. Boonyard, V. et al (2003) Interspousal transmission of hepatitis C in Thailand. Journal of Gastroenterology 38 (2): 1053–1059.

    Article  Google Scholar 

  2. Brook, H. and Stringer, R. (2005) Users, using, used: A beginners guide to deconstructing drugs discourse. International Journal of Drug Policy 16 (5): 316–325.

    Article  Google Scholar 

  3. Bunton, R. (1992) More than a woolly jumper: Health promotion as social regulation. Critical Public Health 3 (2): 4–11.

    Article  Google Scholar 

  4. Conrad, S., Garrett, L., Cooksley, W., Dunne, M. and Macdonald, G. (2006) Living with chronic hepatitis C means ‘you just haven’t got a normal life anymore’. Chronic Illness 2 (2): 121–131.

    Google Scholar 

  5. Crofts, N., Campbell, A. and Kaldor, J. (1999) The force of numbers: Why hepatitis C is spreading among Australian injecting drug users while HIV is not. Medical Journal of Australia 170 (5): 220–221.

    Google Scholar 

  6. Davies, B. and Harre, R. (2001) Positioning: The discursive production of selves. In: M. Wetherell, S. Taylor and S. Yates (eds.) Discourse Theory and Practice: A Reader. Los Angeles, CA: SAGE Publications, pp. 261–271.

    Google Scholar 

  7. Davis, M. and Rhodes, T. (2004a) Managing seen and unseen blood associated with drug injecting: Implications for theorising harm reduction for viral risk. International Journal of Drug Policy 15 (6): 377–384.

    Article  Google Scholar 

  8. Davis, M. and Rhodes, T. (2004b) Beyond prevention? Injecting drug user narratives about hepatitis C. International Journal of Drug Policy 15 (2): 123–131.

    Article  Google Scholar 

  9. Dore, G. (2001) Natural history of hepatitis C virus infection. In: N. Crofts, G. Dore and S. Locarnini (eds.) Hepatitis C: An Australian Perspective. Melbourne, Australia: IP Communications, pp. 82–116.

    Google Scholar 

  10. Douglas, M. (1966) Purity and Danger: An Analysis of the Concepts of Pollution and Taboo. London: Routledge.

    Google Scholar 

  11. Dwyer, R., Fraser, S. and Treloar, C. (2011) Doing things together?:Analysis of health promotion materials to inform hepatitis C prevention among couples. Addiction Research & Theory 9 (4): 352–361.

    Article  Google Scholar 

  12. Faye, B. and Irurita, V. (2003) Balancing perspective: The response to feelings of being condemned with the hepatitis C virus. Journal of Substance Use 8 (2): 92–103.

    Article  Google Scholar 

  13. Fraser, S. (2004) ‘It’s your life!’: Injecting drug users, individual responsibility and hepatitis C prevention. Health 8 (2): 199–221.

    Google Scholar 

  14. Fraser, H. (2008) In the Name of Love: Women's Narratives of Love and Abuse. Toronto, Canada: Women's Press.

    Google Scholar 

  15. Fraser, S. and Seear, K. (2011) Making Disease, Making Citizens: The Politics of Hepatitis C. Surrey, UK: Ashgate Publishing Limited.

    Google Scholar 

  16. Fraser, S. and Treloar, C. (2006) 'Spoiled identity' in hepatitis C infection: The binary logic of despair. Critical Public Health 16 (2): 99–110.

    Article  Google Scholar 

  17. Fraser, S., Treloar, C., Bryant, J. and Rhodes, T. (2014) Hepatitis C prevention education needs to be grounded in social relationships. Drugs, Education, Prevention and Policy 21 (1): 88–92.

    Article  Google Scholar 

  18. Fraser, S.M. and Valentine, K. (2006) ‘Making blood flow’: Materializing blood in body modification and blood-borne virus prevention. Body & Society 12 (1): 97–119.

    Article  Google Scholar 

  19. Grosz, E. (1994) Volatile Bodies: Toward a Corporeal Feminism. Bloomington, IN: Indiana University Press.

    Google Scholar 

  20. Hahn, J. (2007) Sex, drugs and hepatitis C virus: Editorial commentary. The Journal of Infectious Diseases 195 (1): 1556–1559.

    Article  Google Scholar 

  21. Harris, M. (2009) Injecting, infection, illness: Abjection and hepatitis C stigma. Body and Society 15 (33): 33–51.

    Article  Google Scholar 

  22. Harris, M. and Rhodes, T. (2013) Injecting practices in sexual partnerships: Hepatitis C transmission potentials in a 'risk equivalence' framework. Drug and Alcohol Dependence 132 (3): 617–623.

    Article  Google Scholar 

  23. Hepatitis Australia. (2007a) Contact: Post – Test Information for Hepatitis C. ACT: Hepatitis Australia.

  24. Hepatitis Australia. (2007b) Women and Hepatitis C: A Resource for Women with Hepatitis. ACT: Hepatitis Australia.

  25. Hepatitis Australia. (2010) Hepatitis C Testing Information. ACT: Hepatitis Australia.

  26. Hepatitis NSW. ([2008] 2011) Hep C Factsheets: Sex and Hepatitis C Transmission. NSW, Australia: Hepatitis NSW.

  27. Hepatitis NSW. ([2009a] 2013) What You Need to Know: A Guide to Hepatitis C. NSW, Australia: Hepatitis NSW.

  28. Hepatitis NSW. ([2009b] 2011) Hepatitis C: A Brief Introduction. NSW, Australia: Hepatitis NSW.

  29. Hepatitis Queensland. (2009) Sexual Transmission and Hepatitis C (Factsheet 29). Queensland, Australia: Hepatitis Queensland.

  30. Hepatitis South Australia. (2008a) Hep C is Not an STI! Australia: Hepatitis South Australia.

  31. Hepatitis South Australia. (2008b) Hepatitis C: Information for Family and Friends. Australia: Hepatitis South Australia.

  32. Hepatitis Victoria. (2008) Impact: Information About Hepatitis C. Victoria, Canada: Hepatitis Victoria.

  33. Hepatitis Victoria. (2009) Is Hepatitis C sexually Transmitted?. (factsheet) Victoria, Canada: Hepatitis Victoria.

  34. Hepatitis Western Australia. (2007a) Relationships and Problem-Solving (factsheet). WA: Hepatitis WA.

  35. Hepatitis Western Australia. (2007b) Hepatitis C and Sexual Transmission: Does it Occur? (Factsheet) WA: Hepatitis WA.

  36. Hepworth, H. and Krug, G. (1999) Hepatitis C: A socio-cultural perspective on the effects of a new virus on a community's health. Journal of Health Psychology 4 (2): 237–246.

    Article  Google Scholar 

  37. Huggins, R. (2006) The addicts body: Embodiment, drug use, and representation. In: D. Waskul and P. Vannini (eds.) Body/Embodiment: Symbolic Interaction anf the Sociology of the Body. Hampshire, UK: Ashgate Publishing Limited, pp. 165–182.

    Google Scholar 

  38. Kao, J. et al (1996) Transmission of hepatitis C virus between spouses: The important role of exposure duration. American Journal of Gastroenterology 91 (10): 2087–2090.

    Google Scholar 

  39. Keane, H. (2002) What’s Wrong with Addiction? Carlton, Australia: Melbourne University Press.

    Google Scholar 

  40. Keane, H. (2004) Disorders of desire: Addiction and problems of intimacy. Journal of Medical Humanities 25 (3): 189–204.

    Article  Google Scholar 

  41. Krug, G. (1995) Hepatitis C: Discursive domains and epistemic chasms. Journal of Contemporary Ethnography 24 (3): 299–322.

    Article  Google Scholar 

  42. Lenton, E. (2011) Anomalous bodies: Sexuality and intimate relationships in Australian health promotion materials and interviews with people affected by hepatitis C, Masters Thesis, Monash University, Melbourne.

  43. Lenton, E., Fraser, S., Moore, D. and Treloar, C. (2011) Hepatitis C, love and intimacy: Beyond the ‘anomalous body’. Drugs: Education, Prevention and Policy 18 (3): 228–236.

    Google Scholar 

  44. Lupton, D. (1992) Discourse analysis: A new methodology for understanding the ideologies of health and illness. Australian Journal of Public Health 16 (2): 145–150.

    Article  Google Scholar 

  45. McMahon, J., Pouget, E. and Tortu, S. (2007) Individual and couple-level risk factors for hepatitis C infection among heterosexual drug users: A multilevel dyadic analysis. Journal of Infectious Diseases 195 (11): 1572–1581.

    Article  Google Scholar 

  46. Nettleton, S. (2006) The Sociology Of Health and Illness, 2nd edn. Cambridge: Polity Press.

    Google Scholar 

  47. Parker, I. (1992) Discourse Dynamics: Critical Analysis for Social and Individual Psychology. London: Routledge.

    Google Scholar 

  48. Petersen, A. and Lupton, D. (1996) The New Public Health: Health and Self in the Age of Risk. St Leonards, Australia: Allen and Unwin.

    Google Scholar 

  49. Rhodes, T. and Stimson, G. (1994) What is the relationship between drug taking and sexual risk? Social relations and social research. Sociology of Health and Illness 16 (2): 209–228.

    Article  Google Scholar 

  50. Seear, K., Gray, R., Fraser, S., Treloar, C., Bryant, J. and Brener, L. (2012) Rethinking safety and fidelity: The role of love and intimacy in hepatitis C transmission and prevention. Health Sociology Review 21 (3): 272–286.

    Article  Google Scholar 

  51. Shildrick, M. (1997) Leaky Bodies and Boundaries: Feminism, Postmodernism and (Bio)ethics. London: Routledge.

    Google Scholar 

  52. Shildrick, M. (2000) Becoming vulnerable: Contagious encounters and the ethics of risk. Journal of Medical Humanities 21 (4): 215–227.

    Article  Google Scholar 

  53. Shildrick, M. (2002) Embodying the Monster: Encounters with the Vulnerable Self. London: Sage.

    Google Scholar 

  54. Shildrick, M. (2007) Dangerous discourses: Anxiety, desire, and disability. Studies in Gender and Sexuality 8 (3): 221–244.

    Article  Google Scholar 

  55. Simmons, J. and Singer, M. (2006) I love you … and heroin: Care and collusion among drug using couples. Substance Abuse Treatment, Prevention, and Policy 1 (7).

  56. Singer, L. (1993) Erotic Welfare: Sexual Theory and Politics in the Age of Epidemic. New York: Routledge.

    Google Scholar 

  57. Sladden, T., Hickey, A., Dunn, T. and Beard, J. (1998) Hepatitis C virus infection: Impact on behaviour and lifestyle. Australian and New Zealand Journal of Public Health 22 (4): 509–511.

    Article  Google Scholar 

  58. Terrault, N. (2002) Sexual activity as a risk factor for hepatitis C. Hepatology 36 (5): s99–s105.

    Article  Google Scholar 

  59. Terrault, N. et al (2013) Sexual transmission of hepatitis C virus among monogamous heterosexual couples. Hepatology 57 (3): 881–889.

    Article  Google Scholar 

  60. Tohme, R. and Holmberg, S. (2010) Is sexual contact a major mode of hepatitis C virus transmission? Hepatology 52 (4): 1497–1505.

    Article  Google Scholar 

  61. Treloar, C. and Fraser, S. (2004) Hepatitis C, blood and models of the body: New directions for public health. Critical Public Health 14 (4): 377–389.

    Article  Google Scholar 

  62. Vandelli, C. et al (2004) Lack of evidence of sexual transmission of hepatitis C among monogamous couples: Results of a 10-year prospective follow-up study. American Journal of Gastroenterology 99: 855–859, doi:10.1111/j.1572-0241.2004.04150.x.

    Article  Google Scholar 

  63. Victoria Department of Human Services. (2006) Hepatitis C: The Facts. Victoria, Canada: DHS.

  64. Vitellone, N. (2003) The Syringe as a Prosthetic. Body and Society 19 (3): 37–52.

    Article  Google Scholar 

  65. Waldby, C. (1996) AIDS and the Body Politic: Biomedicine and Sexual Difference. London: Routledge.

    Google Scholar 

  66. Wetherell, M. (1998) Positioning and interpretative repertoires: Conversation analysis and post-structuralism in dialogue. Discourse & Societ 9: 387–412.

    Article  Google Scholar 

  67. Winter, R., Fraser, S., Booker, N. and Treloar, C. (2011) Technical Review of Hepatitis C Health Promotion Materials. NSW, Australia: NCHSR.

    Google Scholar 

  68. Zerubavel, E. (1991) The Fine Line: Making Distinctions in Everyday Life. New York: The Free Press.

    Google Scholar 

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Acknowledgements

The interviews referred to in this article were conducted as part of an Australian Research Council-funded study entitled ‘Under construction: The social and cultural politics of hepatitis C’ (DP0877944) and a Masters Project. The former was conducted at Monash University in partnership with the National Drug Research Institute and the National Centre in HIV Social Research. Chief investigators for the project ‘Under construction’ were Suzanne Fraser, Carla Treloar and David Moore. The authors would like to extend their thanks to the organisations that assisted in recruitment for the study, and most importantly of all, to the study participants who gave so generously of their time.

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Correspondence to Emily Lenton.

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Lenton, E., Fraser, S. Hepatitis C health promotion and the anomalous sexual subject. Soc Theory Health 14, 44–65 (2016). https://doi.org/10.1057/sth.2015.6

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Keywords

  • hepatitis C
  • health promotion
  • sexual transmission
  • anomalous bodies
  • gender